Bipolar Disorder vs Borderline Personality Disorder [Differences & How to Spot Them]

[Music] hi i'm kyle kittleson with med circle and tonight we are going to be showcasing our live panel of med circle psychiatrists and psychologists that you can participate in if you register using the links below you can join us live submit your questions interact with other participants and more if you can't join us but we'd still like a recorded video of tonight's panel register and we will send you a recording of that video thanks for being here dr dom joins me today for this session on the differences of treatment when it comes to bipolar disorder and an often misdiagnosed borderline personality disorder dr dom these two are very misdiagnosed all the time i've talked to so many people who were diagnosed with one but then turned out they had the other why is bpd so commonly misdiagnosed as bipolar disorder and vice versa yeah and i completely agree with you kyle i see it all the time from a clinical standpoint as a working psychiatrist and i think you know i think the basis of this comes down to one very simple thing it's that the emotional dysregulation which is the mood instability is misdiagnosed as either mania as as mood disorder like a major depressive episode as anxiety as post-traumatic stress disorder but in many many many cases that mood instability is misdiagnosed as bipolar disorder right so in a nutshell that's really really what happens there and and to be honest with you it goes the other way as well it goes the way of you know people can be quote unquote labeled borderline even if they have another issue again major depressive disorder anxiety post-traumatic stress disorder or even bipolar disorder but they can be labeled borderline if if the psychiatrist or clinician thinks that they're difficult to deal with or non-responsive to the treatments that they're offering or automatically if they're self-injuring for example if they're doing something like scratching oh they must be borderline right so people do jump to conclusions sometimes mislabel misdiagnosed based on a few of those little criteria can somebody i'm assuming the answer is yes but can somebody have a dual diagnosis of bpd and bipolar disorder yeah of course i think you know remember when we used to use like the axis systems right um bipolar disorder would be considered an axis one diagnosis and you know as we talk about this i'll explain some of the differences but yeah you know bipolar disorder is a very heavily weighted genetic hereditary mood disorder that's very rooted in brain chemistry and biology where borderline personality disorder is something that's probably acquired not only through genetic factors but you know temperament and environment and development and bonding and parenting and you know all kinds of things from an environmental standpoint so there's no reason why they both can't co-exist together you know it's a very complicated picture but it can happen um we learned from dr romini in a previous session about the different subtypes of borderline personality disorder also you and i have done serious bipolar disorder and we know there's bipolar 1 and bipolar 2 and certainly even within there different people will experience those symptoms differently so on a high level what are the key differences just in general between bpd and bipolar disorder yeah so let's look at borderline personality disorder borderline personality disorder without getting too specific into the dsm is is intense emotions right rapid shifts in emotions mostly negative though right so so the majority of the the expressed emotions are in a negative connotation and and here's a very very important distinction is in borderline personality disorder there's usually a trigger there's a trigger an environmental or psychosocial trigger of some sort and the response is usually very disproportionate to the actual trigger um and you know people with borderline personality disorder tend to have you know rejection sensitivity difficulty regulating their emotions and again this is based in that lack of sense of self like their foundation in their identity really isn't super coherent so they respond to their environment in a very defensive posture often and that's what we think causes these these sort of very labile mood presentations that that we see as as providers loved ones and caregivers now bipolar disorder on the other hand bipolar disorder is definitely a shift in mood and this is where the confusion comes in because they're both mood disorders in the sense that that you're going to have these labial moods right these changes in moods but bipolar disorder you have shifts in mood but it tends to stay within the depressive affect and the manic type affect right now these these sort of swings and mood are they usually tend to last longer for example people will be in a manic episode for weeks at a time people can be in a depressive episode for weeks to months at a time right it's a much longer time span so these episodes tend to last much longer and when you look at a person with bipolar disorder it's less random and and what i mean by less random um i know i said borderline does respond to triggers but but bipolar disorder doesn't really have a rhyme or reason as to why somebody becomes manic or someone goes into a depressive phase everything could be going amazing from an objective standpoint in someone's life but they'll lock themselves in the room and not come out for days at a time and stop showering stop caring for themselves or they'll become completely manic and blow money that they don't have and do all these things in a manic episode but it doesn't really have a noted trigger it just sort of happens it sort of vacillates on on this biological neurochemical basis right so it's very rarely related to external circumstances where borderline personality disorder you will likely see someone that has a trigger someone will react emotionally whether it be crying or anger impulsivity or suicidality and it will be because someone did this someone said something i overheard this you don't love me whatever it may be there's a reason and that's driving this emotional volcano right where in bipolar disorder you don't see that you just don't see it um and again when we're looking at like ideology too we're looking at like sort of the theories of how these two distinct illnesses come about and when we look at bipolar disorder we do see that it's so genetic which tells us that there's just this enormous biological component right like this biological information that gets inherited um and we know that it's you know a nervous system dysregulation as opposed to just an emotional dysregulation of perception right your perspective is causing this guarded nature with these unhealthy coping strategies as opposed to just your brain going into this hyper-excitable state and this depressed state as in bipolar disorder and from my understanding children can be diagnosed with bipolar disorder correct yeah yeah sure we do see it in children um usually in children if it's true bipolar and you know i am somewhat very very cautious with a diagnosis of bipolar disorder in children um but you usually see the mania more as irritability than like a mania that you would see in adults so there are some nuances when it comes to adult and child presentations of bipolar disorder but it certainly can be diagnosed are there any clear signs that would or could indicate somebody has been misdiagnosed well i think so when we're talking about misdiagnosis i think again evaluating the case and really looking back at the circumstances of that diagnosis and everything that's been going on so so misdiagnosis let's let's just say number one they're not responding to the treatment that we're presenting right so that's a reason to re-evaluate and reassess the diagnosis and that goes with anything in behavioral health to be honest with you if you're not responding to a few trials of a certain medication or a few different therapists who are trying a certain type of psychotherapeutic intervention you might want to rethink that diagnosis right so that could potentially be a misdiagnosis and you know bipolar disorder as as difficult as it is does tend to respond well to psychopharmacology so we can reduce for example very objectively and you know with data we can reduce the amount of manic episodes people have like in a year right with medications we can reduce the amount of depressive episodes that someone has over the course of a year and this can be really plotted out and documented with medication and medication regimen borderline personality disorder however is very challenging to treat and again sometimes you're just chasing specific symptoms so you know if someone's not getting better you really need to look at that diagnosis because potentially someone that you think is bipolar and you're treating with bipolar medicines but their moods are still all over the place their relationships are falling apart you know they're having all this impulsivity and agitation then you might want to think more of a personality disorder and and vice versa do any stories come to mind when you have been working with a patient who came to you with a diagnosis only for you to realize that they were misdiagnosed and you got them the correct diagnosis yeah you know sure and and i think of course that happens and and it's happened to me on multiple occasions and you know um again i think some clinicians especially with borderline personality disorder can jump to that conclusion very quickly if people present very emotionally labile if they engage in self-injury if they're very difficult to deal with right they'll say oh that person's borderline they're just borderline and you know it's actually very disheartening for me to hear that because it's you know they're not going to get the right treatment number one and it's almost as if they're giving up on oh they're borderline right in reality listen people can be irritable for a million reasons people can self-injure for a million reasons and and you know i've worked with patients that were diagnosed as borderline when in reality they they were very very depressed and it was manifesting as irritability and self-injury and isolation and difficulty with relationships right and you focus on depression treatment and they do well and they become very very stable so so yeah i think it's really important for clinicians out there for psychiatrists like myself to not jump to any conclusions and make sure especially listen bipolar is complex borderline is complex i think in these cases you should probably should be working with a team no matter what this isn't run-of-the-mill depression or anxiety so you know to avoid that misdiagnosis i think even more so as we talked about before working with a team and making sure that you refer to a psychotherapist and have a good collaborative relationship with that therapist to really talk about these things let's not forget something there's something called counter transference counter transference in psychology is when you start to feel this discomfort from a patient and their emotional reactions right and and borderline personality disorder tends to have a lot of counter transference to the therapists and the clinicians that are treating them so also sometimes and that should not be a reason for diagnosis but i've seen people say oh my god there was so much counter transference there they must be borderline well no that's definitely not the case um but that's why you need to work with a therapist because i can call the therapist and talk to them and say you know i was experiencing a lot of counter transference with this patient i was i was getting a very uncomfortable feeling in a vibe do you think that they're potentially experiencing a borderline personality disorder and that's a discussion that two professionals should absolutely have yeah you you you mentioned something earlier that i thought was really interesting i think of irritability and saying you know this person was diagnosed with borderline personality disorder and it could have been that the that person doing the diagnosis uh saw that they were irritable assumes that is the symptom related to bpd and makes that diagnosis but irritability shows up in lots of different mental health diagnoses like like depression so how does a clinician or even an individual really determine when a symptom is associated with a specific type of mental health disorder and not another type of mental health disorder yeah that's that's where that thorough evaluation comes in and you know a psychiatric evaluation is pretty algorithmic you know there's a protocol to it and you know it starts out with gathering as much history and collateral information as you can right so you know where you're going to do with a thorough evaluation is not only spend a significant amount of time with the individual you know feeling out all of these different symptoms that they're experienced subjectively but you're also going to hopefully talk to caregivers and loved ones maybe teachers parents um whoever it may be that may observe the patient on various in various different environments throughout the week to get a get an understanding get a firm understanding now remember when you're doing a diagnosis in psychiatry you're looking at developmental history you're looking at childhood you're looking at medical history so you're really weeding out so much and if you do a thorough evaluation and you have good collateral history then honestly it's it's hard to it's hard to miss i i think you know i think misdiagnoses come from not doing the due diligence that you should as a clinician to really dig deep and and get as much information as you can and you know you don't have to get the diagnosis in the first meeting either and i think you know patients and family need to know that too you know you know one hour spending one hour with somebody you know you might not get a diagnosis right like some sometimes sometimes it's incredibly evident right and even then even then you say listen this is what i'm thinking however we're going to meet some more i'm going to talk to some other people in your family that you gave me you know maybe we can have a family session a group session i'm going to speak with you know your your loved ones your caregivers um we're going to gather some more history and i'm going to see you next week and we're going to see how the week goes we're going to talk about what's going on so you're just going to get so much information and you don't need to make a diagnosis that first meeting yeah i you know i remember seeing my last psychiatrist i don't see him anymore um and i had seen him for maybe a year and one day in the middle of our session he started asking me these questions questions like uh do you spend do you find yourself spending money you don't have do you find yourself staying up for days at a time uh do you find yourself uh you know writing you know plays or books you know for for a week and then not and i i said no and i knew or i assumed that he was uh probing me to see if i might be showing symptoms of bipolar uh disorder and my first internal reaction to that was we've been together a year how have you not seen this now if i do have biblical disorder but then i changed to be very appreciative that he was open to the idea that he might be wrong or maybe i gave him wrong information you know i can't i'm saying i have this diagnosis of depression so i really appreciated that he would explore these things that he sees and not let go get in the way of no i already decided he's depression so it can't be anything else um i just want to share that story uh that's that's such an important story and that brings a few important points to me that i would like to convey and that is number one be as open and honest with your therapist and psychiatrist as you can because you're absolutely right they only know what you tell them so if you're guarded or afraid to tell them things it's going to sabotage your own treatment really and it's it's not going to lend to a good outcome so you really want to be honest and open about your symptoms the other thing is you know remember clinicians when they're making a diagnosis whether it's a psychiatrist or a psychotherapist it's not only about ruling things in right like we can all just hit that check box like do you spend money uh do you get yourself into trouble do you not get out of bed in the morning okay check check check you have this it's also if you read the dsm there's always a blurb there that says and is not better accounted for by another diagnosis so you might be able to rule all those things in but you know what you have to roll the other things out right so that's a very very important part of this process as well but great great points excellent well we're going to talk more about these topics tonight during our live panel if you'd like to join live or get the replay sent to you use the links below and thank you for subscribing liking and turning on the notifications to this youtube channel it supports us and that helps us support you i'm kyle kiddleson remember whatever you're going through you got this

Channel: MedCircle

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Keywords: bipolar, bipolar disorder, disorder, borderline personality disorder, bpd, differences, depression, mania, psychiatry, psychology, personality, personality disorders, narcissism, narcissist, narcissistic, narcissistic personality disorder, medcircle, dr ramani, mental health, mental illness, antisocial personality disorder, histrionic personality disorder, avoidant personality disorder, paranoid personality disorder, multiple personality disorder, video, borderline, youtube, behavior, hypomania, help

Id: i46a9MfdCmk

Length: 18min 6sec (1086 seconds)

Published: Thu Feb 04 2021